Ignite Creation Date:
2024-05-06 @ 4:00 PM
Last Modification Date:
2024-10-26 @ 2:01 PM
Study NCT ID:
NCT04834479
Status:
UNKNOWN
Last Update Posted:
2021-04-08
First Post:
2021-04-04
Brief Title:
Assessment of Accuracy of Ultrasonography in Diagnosis of Non-osseous Lateral Ankle Instability in Comparison With Magnetic Resonance Imaging
Sponsor:
Assiut University
Organization:
Assiut University
Study Overview
Official Title:
Assessment of Accuracy of Ultrasonography in Diagnosis of Non-osseous Lateral Ankle Instability in Comparison With Magnetic Resonance Imaging
Status:
UNKNOWN
Status Verified Date:
2021-03
Last Known Status:
RECRUITING
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Chronic ankle instability CAI is a condition that often develops after repeated ankle sprains increasing the susceptibility of the ankle to move into excessive inversion when walking on unsteady surfaces Approximately 74 of acute ankle sprains result in persistent symptoms 30 of which progress to chronic ankle instability Arthroscopic examination and magnetic resonance imaging MRI are considered the two most accurate methods of diagnosing injuries to lateral collateral ligaments Ultrasound has been proven able to detect soft tissue injuries However the use of ultrasound and its ability to accurately diagnose CAI is still under debate The aim of this study is to investigate the diagnostic accuracy of ultrasonography for the assessment of non-osseous lateral ankle instability in comparison with magnetic resonance imaging MRI
Detailed Description:
Chronic ankle instability CAI is a condition that often develops after repeated ankle sprains increasing the susceptibility of the ankle to move into excessive inversion when walking on unsteady surfaces Approximately 74 of acute ankle sprains result in persistent symptoms 30 of which progress to chronic ankle instability1-3 CAI is diagnosed in individuals who report pain and tenderness on the lateral aspect of the ankle or persistent swelling and discomfort for greater than six months with a history of re-injury or clinical instability of the ankle joint4 5 The primary cause of damage to the structural stability of the ankle joint is trauma by forced inversion and plantarflexion The lateral collateral ligaments which are more commonly affected by acute sprains include the anterior talofibular ligament ATFL the calcaneofibular ligament CFL and the posterior talofibular ligament PTFL The ATFL is primarily responsible for preventing excessive supination and anterior translation while also restricting plantar flexion and internal rotation
Common diagnostic tools used to identify ankle instability include clinical testing like Anterior Drawer Test imaging and arthroscopy Arthroscopic examination and magnetic resonance imaging MRI are considered the two most accurate methods of diagnosing injuries to lateral collateral ligaments 7 In a retrospective study conducted by Joshy et al in which 24 patients underwent arthroscopy and MRI of the ankle MRI was found to have both high specificity 100 and high sensitivity 100 for ATFL disruption 8-10 Ultrasound has been proven able to detect soft tissue injuries and has even become the gold standard for the detection of injuries to the patellar and Achilles tendons 2 11 However the use of ultrasound and its ability to accurately diagnose CAI is still under debate
When imaging the ankle ultrasound should be able to detect synovial lesions ligamentous injury and distinguish soft tissue from osseous impingement8 Dynamic ultrasound should be also used to discover dislocation of the peroneal tendons or intra-sheath dislocation which is indicated by an intact retinaculum with subluxation of the peroneal tendons within the groove11 Aim of the work The aim of this study is to investigate the diagnostic accuracy of ultrasonography for the assessment of non-osseous lateral ankle instability in comparison with magnetic resonance imaging MRI
Patients and Methods
fifty four patients complaining of acute or chronic lateral ankle instability will be included in this study
Inclusion criteria
Patients complaining of acute or chronic lateral ankle instability
Exclusion criteria
Previous ankle surgery
Interventional intra-articular procedures previous arthroscope injections
Systemic inflammatory disorders collagen diseases
Diagnosed osseous lesions
Methods
All patients will be subjected to
Thorough history taking and clinical provisional diagnosis Plain X-ray of the affected ankle in AP and lateral views to exclude any osseous lesions
Real-time high resolution ultrasonography of the affected ankle joint MRI for the affected ankle joint
Ultrasound Technique
The ultrasonographic examination of the ankle begins with the patient in supine position Longitudinal scanning of the ankle was first performed to get an overall view of the tibio-talar joint and to detect joint effusion Thereafter slight inversion of the foot is performed while the patient in the same position to examine the lateral collateral ligaments and peroneal tendons The Anterior talo-fibular ligament ATFL is first examined in oblique transverse plane from the tip of lateral malleolus antero-medially and slightly downward till the talus Then the Calcaneo Fibular ligament CFL is examined in oblique longitudinal plane from the lateral malleolar tip downward and slightly backward to the lateral surface of the calcaneus
Regarding the peroneal tendons they are examined from their supra-malleolar musculo-tendinous junction and then just behind the lateral malleolus till their infra-malleolar course in both longitudinal and transverse planes
MRI examination All patients will have MRI imaging of the affected ankles on a high field-strength scanners
Positioning
Every patient lies supine with the ankle and foot in neutral position and plantar flexion of 20-30 degrees for reducing the magic angle artifact No movement allowed during examination by supporting the ankle using pads
Protocol
The patients are examined by different pulse sequences including T1 T2 proton density gradient echo and STIR The examinations will be done in different planes
Our usual protocol of examination is Sagittal T1WIs Axial T1WIs T2WIs and proton density images coronal T1WIs as well as Sagittal or coronal STIR
Other parameters applied include slice thickness ranged from 3 to 5 mm matrix 256192 or 512224 number of excitation 2 to 3 and field of view ranged from 12 to 16 cm better kept 14 cm
Common diagnostic tools used to identify ankle instability include clinical testing like Anterior Drawer Test imaging and arthroscopy Arthroscopic examination and magnetic resonance imaging MRI are considered the two most accurate methods of diagnosing injuries to lateral collateral ligaments 7 In a retrospective study conducted by Joshy et al in which 24 patients underwent arthroscopy and MRI of the ankle MRI was found to have both high specificity 100 and high sensitivity 100 for ATFL disruption 8-10 Ultrasound has been proven able to detect soft tissue injuries and has even become the gold standard for the detection of injuries to the patellar and Achilles tendons 2 11 However the use of ultrasound and its ability to accurately diagnose CAI is still under debate
When imaging the ankle ultrasound should be able to detect synovial lesions ligamentous injury and distinguish soft tissue from osseous impingement8 Dynamic ultrasound should be also used to discover dislocation of the peroneal tendons or intra-sheath dislocation which is indicated by an intact retinaculum with subluxation of the peroneal tendons within the groove11 Aim of the work The aim of this study is to investigate the diagnostic accuracy of ultrasonography for the assessment of non-osseous lateral ankle instability in comparison with magnetic resonance imaging MRI
Patients and Methods
fifty four patients complaining of acute or chronic lateral ankle instability will be included in this study
Inclusion criteria
Patients complaining of acute or chronic lateral ankle instability
Exclusion criteria
Previous ankle surgery
Interventional intra-articular procedures previous arthroscope injections
Systemic inflammatory disorders collagen diseases
Diagnosed osseous lesions
Methods
All patients will be subjected to
Thorough history taking and clinical provisional diagnosis Plain X-ray of the affected ankle in AP and lateral views to exclude any osseous lesions
Real-time high resolution ultrasonography of the affected ankle joint MRI for the affected ankle joint
Ultrasound Technique
The ultrasonographic examination of the ankle begins with the patient in supine position Longitudinal scanning of the ankle was first performed to get an overall view of the tibio-talar joint and to detect joint effusion Thereafter slight inversion of the foot is performed while the patient in the same position to examine the lateral collateral ligaments and peroneal tendons The Anterior talo-fibular ligament ATFL is first examined in oblique transverse plane from the tip of lateral malleolus antero-medially and slightly downward till the talus Then the Calcaneo Fibular ligament CFL is examined in oblique longitudinal plane from the lateral malleolar tip downward and slightly backward to the lateral surface of the calcaneus
Regarding the peroneal tendons they are examined from their supra-malleolar musculo-tendinous junction and then just behind the lateral malleolus till their infra-malleolar course in both longitudinal and transverse planes
MRI examination All patients will have MRI imaging of the affected ankles on a high field-strength scanners
Positioning
Every patient lies supine with the ankle and foot in neutral position and plantar flexion of 20-30 degrees for reducing the magic angle artifact No movement allowed during examination by supporting the ankle using pads
Protocol
The patients are examined by different pulse sequences including T1 T2 proton density gradient echo and STIR The examinations will be done in different planes
Our usual protocol of examination is Sagittal T1WIs Axial T1WIs T2WIs and proton density images coronal T1WIs as well as Sagittal or coronal STIR
Other parameters applied include slice thickness ranged from 3 to 5 mm matrix 256192 or 512224 number of excitation 2 to 3 and field of view ranged from 12 to 16 cm better kept 14 cm
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None